How reflux wear looks different

Brushing wear shows up as notches at the gumline on the cheek side of teeth. Reflux wear shows up on the inside of the upper front teeth and the chewing surfaces of the back teeth, the surfaces acid washes over when you lie down. Those surfaces go smooth and glassy, then thin, then the yellower dentin underneath starts to show through.

Old fillings can start to stand proud of the tooth because the enamel around them has dissolved while the filling has not.

Signs you might notice

Silent reflux, with no heartburn at all, is common. Sometimes the teeth are the first place it shows.

• A sour or bitter taste when you wake up
• Front teeth that look more transparent or yellow at the edges
• New sensitivity to cold or sweet, especially on the back teeth
• Teeth that feel rough or sharp along the biting edge
• Heartburn, or a cough or hoarseness at night without a cold

What to do at home

• After reflux or vomiting, rinse with water or a baking-soda rinse. Do not brush for about 30 to 60 minutes, because softened enamel brushes away
• Use a soft brush and a fluoride toothpaste; fluoride helps enamel re-harden
• Avoid eating within two to three hours of lying down, and raise the head of the bed if nights are the problem
• Talk to your physician. Controlling the reflux is the real fix, and I will write a note if that helps

What I do at mend

I note which surfaces are affected and photograph them so we can compare at future visits. Professional fluoride after cleanings helps harden remaining enamel and calm sensitivity. Where enamel is thin but intact, we watch. Where it has worn through or a tooth has become sharp or sensitive, composite bonding rebuilds the surface with minimal drilling. For teeth that have lost a lot of height, onlays or crowns restore the bite.

Treating the mouth without treating the reflux is a losing race, so the first conversation is often about getting you to the right physician.